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The Kenyan government launched a Universal Health Coverage (UHC) pilot project in 2019 across four counties—Isiolo, Kisumu, Machakos, and Nyeri—to eliminate user fees and address healthcare gaps. A mixed-methods study revealed that the pilot increased healthcare utilization due to the removal of fees and improved access to essential medicines. However, challenges included unclear relationships with existing financing, a poorly defined benefit package, funding flow issues, limited provider autonomy, and inadequate infrastructure.